Healthcare Provider Details

I. General information

NPI: 1255690939
Provider Name (Legal Business Name): LINDSAY MARIE ROGERS D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 S GRANT ST
MISSOULA MT
59801-8341
US

IV. Provider business mailing address

3111 S GRANT ST
MISSOULA MT
59801-8341
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-7532
  • Fax:
Mailing address:
  • Phone: 406-543-7532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9485
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2141
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: